Provider Demographics
NPI:1851934806
Name:MILLER, NICOLE A (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 HELMSLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2983
Mailing Address - Country:US
Mailing Address - Phone:240-355-1283
Mailing Address - Fax:
Practice Address - Street 1:6188 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3113
Practice Address - Country:US
Practice Address - Phone:301-567-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50080614104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker